Consolidated CDA (C-CDA)
3.0.0 - STU3 United States of America flag

This page is part of the CCDA: Consolidated CDA Release (v3.0.0: CCDA 3.0) generated with FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Binary: Patient Generated Document recordTarget

This content is an example of the US Realm Header for Patient Generated Document Logical Model and is not a FHIR Resource

    
<recordTarget xmlns="urn:hl7-org:v3"> <!-- xmlns:sdtc="urn:hl7-org:sdtc"> -->
  <patientRole>
    <id extension="444-22-2222" root="2.16.840.1.113883.4.1" />
    <!-- Example Social Security Number using the actual SSN OID. -->
    <addr use="HP">
      <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
      <streetAddressLine>2222 Home Street</streetAddressLine>
      <city>Beaverton</city>
      <state>OR</state>
      <postalCode>97867</postalCode>
      <country>US</country>
      <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
    </addr>
    <telecom value="tel:+1(555)555-2003" use="HP" />
    <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
    <patient>
      <!-- The first name element represents what the patient is known as -->
      <name use="L">
        <given>Eve</given>
        <!-- The "SP" is "Spouse" from
                     HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
        <family qualifier="SP">Betterhalf</family>
      </name>
      <!-- The second name element represents another name 
                 associated with the patient -->
      <name>
        <given>Eve</given>
        <!-- The "BR" is "Birth" from 
                     HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
        <family qualifier="BR">Everywoman</family>
      </name>
      <administrativeGenderCode code="F" displayName="Female" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender" />
      <!-- Date of birth need only be precise to the day -->
      <birthTime value="19750501" />
      <maritalStatusCode code="M" displayName="Married" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode" />
      <religiousAffiliationCode code="1013" displayName="Christian (non-Catholic, non-specific)" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="HL7 Religious Affiliation" />
      <!-- CDC Race and Ethnicity code set contains the five minimum
                 race and ethnicity categories defined by OMB Standards -->
      <raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" />
      <!-- The raceCode extension is only used if raceCode is valued -->
      <!-- <sdtc:raceCode code="2076-8" displayName="Hawaiian or Other Pacific Islander" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" /> -->
      <ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" />
      <guardian>
        <id root="2.16.840.1.113883.4.1" extension="111-22-3333" />
        <code code="POWATT" displayName="Power of Attorney" codeSystem="2.16.840.1.113883.5.111"/>
        <addr use="HP">
          <streetAddressLine>2222 Home Street</streetAddressLine>
          <city>Beaverton</city>
          <state>OR</state>
          <postalCode>97867</postalCode>
          <country>US</country>
        </addr>
        <telecom value="tel:+1(555)555-2008" use="MC" />
        <guardianPerson>
          <name>
            <given>Boris</given>
            <given qualifier="CL">Bo</given>
            <family>Betterhalf</family>
          </name>
        </guardianPerson>
      </guardian>
      <birthplace>
        <place>
          <addr>
            <streetAddressLine>4444 Home Street</streetAddressLine>
            <city>Beaverton</city>
            <state>OR</state>
            <postalCode>97867</postalCode>
            <country>US</country>
          </addr>
        </place>
      </birthplace>
      <languageCommunication>
        <languageCode code="en" />
        <!-- "eng" is ISO 639-2 alpha-3 code for "English" -->
        <modeCode code="ESP" displayName="Expressed spoken" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode" />
        <proficiencyLevelCode code="G" displayName="Good" codeSystem="2.16.840.1.113883.5.61" codeSystemName="LanguageAbilityProficiency" />
        <!-- Patient's preferred language -->
        <preferenceInd value="true" />
      </languageCommunication>
    </patient>
    <providerOrganization>
      <id extension="219BX" root="1.1.1.1.1.1.1.1.2" />
      <name>The DoctorsTogether Physician Group</name>
      <telecom use="WP" value="tel:+(555)-555-5000" />
      <addr>
        <streetAddressLine>1007 Health Drive</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>99123</postalCode>
        <country>US</country>
      </addr>
    </providerOrganization>
  </patientRole>
</recordTarget>